National hospice study reveals gaps ...(researchers analyzed factors that associ...),Health

For example, the more households with incomes over $100,000, or residents who held at least a high school diploma, the better the access to hospice. But surprisingly, the higher the percentage of older residents, the lower the availability of hospice.

Although the dramatic differences revealed by the analysis surprised Silveira and her colleagues, they strongly suspect they know why hospice availability varies so much.

Relying on the ability of patients or their families to pay for care and services that arent covered by Medicare or other insurance and counting on charity and volunteers to make ends meet means that hospices are most likely to flourish in areas where incomes are highest, she explains.

Since 1982, Medicare has paid for hospice, and now pays for the vast majority of such care provided in the U.S. But it only reimburses 70 percent of the cost for certain services, and hospices must make up the difference in out-of-pocket charges, charity donations and volunteerism, she says. Also, nursing homes, which care for many elderly people, currently have little incentive to offer hospice services.

The disparities seen in the new analysis will only fade if there are changes in the way hospices are built and reimbursed for their care, says Silveira, an assistant professor of internal medicine at U-M and a member of the Health Service Research & Development Center of Excellence at the VA Ann Arbor Healthcare System.

And that, in turn, could erase the differences in hospice use that have been reported nationwide by other researchers.

To make hospice more available to more people, Medicare would have to subsidize the building of
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